VENTRICULAR SEPTAL-DEFECT AFTER ACUTE MYOCARDIAL-INFARCTION - EARLY REPAIR

Google Scholar
  • 1 January 1980
    • journal article
    • research article
    • Vol. 80  (1) , 61-67
Abstract
Patients (38) were operated upon early after acute myocardial infarction with rupture of the ventricular septum. Preoperative management included bedside hemodynamic evaluation, mechanical left heart support and pharmacologic agents. Results of the surgical repair reflected the effectiveness and the duration of preoperative treatment. Operation was performed in 14 patients with refractory cardiogenic shock, 10 of whom died (71%). Hemodynamic and clinical stability was achieved in 24 patients. Early operation (average 46 h of medical management) in 17 patients permitted accurate repair, even with friable tissues; 4 of these patients died (23%). Delayed operation (average 12 days of nonoperative treatment) was performed in 7 patients and resulted in a higher mortality rate, 3 patiets dying (43%). The location of the ventricular septal defect (VSD) influenced the operative risks; the prognosis for posterior defects were worse than that for anterior defects. Optimal myocardial preservation during the entire procedure is of crucial importance to the success of the operation.